CDCs National Center for Health Statistics (NCHS) developed the ICD-10-CM, code set.

CMS developed the ICD-10-PCS procedure coding system Reasons to switch to ICD-10 and ICD-10-PCS: 1. ICD-9-CM is outdated and insufficient to continue to allow for addition of new codes 2. Many chapters are full and in others the hierarchical structure of the procedure code set is compromised. 3. Code set was not designed to provide the increased level of detail needed to support emerging needs such as biosurveillance and P4P. 4. New code set are flexible and provide unique codes for all substantially different health conditions 5. New code sets provide specific diagnosis and treatment information that can improve quality measurements and patient safety. 6. New codes have a higher level of specificity with much more information and detail. 7. Facilitate timely electronic processing of claims by reducing requests for additional information. 8. Significant improvements in coding primary care encounters, external causes of injury, mental disorders, neoplasms and preventive health. 9. Reflects current clinical understanding and technological advances in medicine. 10. Accommodates the capture of more detail on socioeconomics, ambulatory care conditions, problems related to lifestyle and the results of screening tests. 11. Laterality for specifying which organ or part of the body is involved. Can reduce duplicate payments and/or claims, and better inform research on conditions that may affect only one area of the body. 12. ICD-10 is the international standard to report and monitor diseases and mortality. This discrepancy makes worldwide standardized reporting difficult in cases of pandemics and other world health issues. ICD-9 is no longer supported by WHO. 13. Necessary to fully realize the benefits of HIT adoption. 14. Creation of diagnosis/symptom combination codes, which may allow for reporting of fewer ICD-10 codes.

ICD-9-CM Vol 1&2 14,432

Number of Codes ICD-10-CM ICD-9-CM Vol 3 69,368 3,768

ICD-10-PCS 86,916

training materials for coders.

Incurred costs of $130 million per year beginning 3 years after the publication of the final rule, and ending 3 years after implementation. AAPC, AHA and AHIMA will take lead roles in developing additional, more detailed technical training materials for coders. According to the AAPC a coder should expect to devote around forty to sixty hours towards ICD-10 education prior to implementation. Productivity can be expected to return to normal about four to six months after the official implementation date. Estimate of the number of coders who would require ICD-10-CM and ICD-10-PCS training: Part-time coders 179,267 Full-time inpatient coders 50,000 Estimate of cost for a typical community hospital to implement the ICD-10 code sets: $1,003,986 Estimate of productivity loss in 2014 through 2017:
Cost Classification Inpatient coders Outpatient coders Physician practices Improper and returned claims 2014 $9.8 M $9.4 M $12.1 M $0 2015 $0 $0 $0 $329.4 M 2016 $0 $0 $0 $164.7 M 2017 $0 $0 $0 $49.4 M

Estimate of individual training costs (includes training cost plus lost productivity): Classification Inpatient coders Outpatient coders Physicians Ancillary staff Hours Needed 50 10 8 8 Cost $3,219 $644 $1,260 $250

Estimate of total training costs to implement ICD-10 code sets: Classification Inpatient coders Outpatient coders Physicians Ancillary staff 2013 $31.8 M $11.9 M $104.3 M $4.1 M 2014 $159.0 M $95.7 M $834.5 M $32.9 M 2015 $21.2 M $11.9 M $104.3 M $4.1 M 2

Estimate of system changes costs: System Type Practice Management Software vendors Payers Medicaid Time Period 4 years 4 years 4 years 4 years Cost $150.6 M $115.3 M $197.6 M $511.9 M

1. Cash flow problems for providers a. There may be a delay as how the payers interpret the new coding system is assessed. b. Payments and remittance advices will need to be closely scrutinized to ensure that claims have been processed appropriately. 2. Increased denied claims a. When additional information is required, it must be sent in a timely manner. b. Staff must be prepared to focus on assessing payer responses throughout the first few months of implementation to identify deficiencies immediately. 3. Temporary increase of physician coding errors 4. Decreased coder productivity before and after implementation a. Productivity can be expected to return to normal about four to six months after the official implementation date. b. Productivity may never return to normal 1) Today, diagnosis codes are mostly numeric (with the exception of V and E codes), but with ICD-10 the codes are alphanumeric. 2) The process of entering the new codes alone will slow productivity because coders will no longer be able to rely solely on a number keypad to enter all the codes. 3) It will be very important to distinguish between letters and numbers when a diagnosis code is written as opposed to a narrative description. For instance, depending on penmanship, it may be easy to mistake a number two for the letter Z, or the number zero for the letter O. c. Management should measure productivity before implementation as a baseline. 5. Increased claims re-billing Federal Register/Vol. 74, No. 11/Friday, January 16, 2009, pp 3328-3362 The October 1, 2011 update is the last regular update for both code sets before the partial freeze. To prepare for the final ICD-10 conversion, limited updates to both code sets will be made October 1, 2012 to capture new technologies and diseases only. Conversion to ICD-10 takes place October 1, 2013, at which time the ICD-10 code set will be updated to capture new technologies and diseases only. Regular, annual updates to the ICD-10 code set will begin Oct. 1, 2014. 3

Description Step 1: Organize the Implementation Effort Step 2: Develop Communication Plan Step 3: Conduct Impact Analysis Step 4: Organize Cross Functional Efforts Step 5: Develop Budget Step 6: Internal System Design and Development Step 7: Development of the Training Plan Step 8: Vendor Strategies Step 9: Implementation Planning Step 10: Phase I Training Step 11: Business Process Analysis Step 12: Education and Training, Phase II Step 13: Policy Change Development Step 14: Outcomes Measurement Step 15: Deployment of Code by Vendors to Customers Step 16: Implementation Compliance

Start 01/01/11 02/01/11 03/01/11 04/01/11 04/01/11 05/01/11 07/01/11 07/01/11 08/01/11 10/01/11 12/01/11 01/01/13 01/01/13 01/01/13 01/01/13 10/01/13

Complete 01/31/11 02/28/11 07/31/11 08/31/11 11/30/11 11/30/11 12/30/11 09/30/11 06/30/12 06/30/11 06/30/13 06/30/13 04/30/13 08/31/13 05/31/13 09/30/14

Step 1 1. Review ICD-10 Final Rule. 2. Appoint a project leader. 3. Brief senior management and organization to achieve buy-in. a. Complete risk assessment and analysis of system impact b. Prepare briefing materials for senior management, providers and staff to obtain support. c. Identify a senior manager project supporter. d. Establish role of senior management in project. 4. Identify all areas of the practice that will be impacted such as the clinical areas, systems, documentation, training, etc. and share information with providers. 5. Establish a regular schedule to report progress to senior management. 6. Coordinate with the 5010 project team.

Step 2 1. Develop materials to disseminate to managers, staff and providers including preliminary information on timeframe and training. 2. Develop a process for conducting periodic briefings for staff. a. Frequency b. Method: inclusion in regularly scheduled meetings, newsletter, e-mail, memo, etc. Step 3 1. Perform in-depth impact analysis to identify resources needed to implement ICD-10. a. Review regulatory requirements. b. Identify existing systems, processes and technology that will be impacted. 4

2. Determine education/training requirements and expectations by: a. Department b. User c. System both internal and external (vendors) 3. Identify hardware and software needs and contact vendors for potential costs and timelines for updating, purchase and/or replacement (in the event systems cannot be updated to accommodate ICD-10 requirements). 4. Identify funding for the project and seek approval from management or providers. 5. Create a timeline for implementation including task, person responsible, date started and date completed. a. Coordinate with 5010 project team b. Coordinate with EMR implementation team. 6. Review existing operations and consider areas of improvement in processes, patient flow, performance, quality, etc. that will ease the implementation of ICD-10.

1. Books 2. Forms 3. NCD/LCD 4. Third party payer policies 5. Policies and procedures 6. Superbills 7. Computer software 8. Computer hardware 9. Practice management systems 10. Vendors 11. EMR 12. PQRS/Quality improvement programs 13. Historical data, trends, comparisons 14. Prescriptions on file with pharmacies 15. Coder certification 16. Data entry 17. Productivity 18. Referrals (lab, radiology, DME, HHA)

Structural differences in ICD-10-CM ICD-10-CM has 3-7 digits Digit 1 is alpha (A-Z, not case sensitive) Digit 2 is numeric Digit 3 is alpha (not case sensitive) or numeric Digits 4-7 are alpha (not case sensitive) or numeric Examples o A66 Yaws o M54.3 Sciatica o A69.20 Lyme disease, unspecified o O9A.311 Physical abuse complicating pregnancy, first trimester o S42.001A Fracture of unspecified part of right clavicle, initial encounter for closed fracture o T36.0x1A Poisoning by penicillins, accidental (unintentional), initial encounter

Chronic gout due to renal impairment, left shoulder, without tophus

M1A.3120
Extension: without tophus Category: Chronic Gout Laterality: Left Location: Shoulder Etiology: Renal impairment

Example of Increased Specificity Patient fractures left wrist o A month later, fractures right wrist o ICD-9-CM does not identify left versus right o Additional documentation is required ICD-10-CM describes o Left versus right o Initial encounter, subsequent encounter o Routine healing, delayed healing, nonunion or malunion 6

814.01 S62.011B S62.021B S62.031B

Closed fracture of navicular (scaphoid) bone of wrist Displaced fracture of distal pole of navicular (scaphoid) bone of right wrist, initial encounter for closed fracture Displaced fracture of middle third of navicular (scaphoid) bone of right wrist, initial encounter for closed fracture Displaced fracture of proximal third of navicular (scaphoid) bone of right wrist, initial encounter for closed fracture

Example of laterality C50.1 C50.11 C50.111 C50.112 Malignant neoplasm, of central portion of breast Malignant neoplasm, of central portion of breast, female Malignant neoplasm, of central portion of right female breast Malignant neoplasm, of central portion of left female breast

Example of trimesters added to obstetrical codes V22.1 Z34.81 Z34.82 Prenatal care, normal, other pregnancy Encounter for supervision of other normal pregnancy, first trimester Encounter for supervision of other normal pregnancy, second trimester

Comparison of ICD-9 to ICD-10 codes

Description Asthma, unspecified Poisoning by digoxin Pre-op exam, cardiology Well woman exam Ankle sprain Shortness of breath Diabetes, Type I Diabetes, Type II with polyneuropathy Prenatal care, normal, other pregnancy ICD-9 493.90 972.1 V72.81 V72.31 845.00 786.05 250.01 250.60, 357.2 V22.1 ICD-10 J45.909 T46.0x1A Z01.810 Z01.419 S93.409A R06.02 E10.9 E11.42 Z34.80